Individual
THERESA JOANNE SHANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1650 COWLES ST, FAIRBANKS, AK 99701-5925
(907) 458-5660
Mailing address
PO BOX 70378, FAIRBANKS, AK 99707-0378
(907) 456-2784
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5533
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD7338
—
AK
Enumeration date
08/19/2006
Last updated
07/08/2007
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